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Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors.

Publication ,  Journal Article
Armenian, SH; Horak, D; Scott, JM; Mills, G; Siyahian, A; Berano Teh, J; Douglas, PS; Forman, SJ; Bhatia, S; Jones, LW
Published in: Biol Blood Marrow Transplant
April 2017

Peak oxygen consumption (VO2peak), as measured by cardiopulmonary exercise testing (CPET), is a powerful independent predictor of cardiovascular disease (CVD) and all-cause mortality in a broad range of populations. We assessed the safety and feasibility of CPET in aging long-term hematopoietic cell transplantation (HCT) survivors, a population at high risk for premature onset of CVD. Next, we examined how organ-specific impairments (eg, cardiac, pulmonary, hematologic) impact VO2peak after HCT. Twenty consecutive HCT survivors underwent a comprehensive assessment of cardiopulmonary health that included CPET, echocardiography with strain, pulmonary function testing, 6-minute walk test, and timed up and go. Median age at assessment was 67.4 years (range, 42 to 75), and median time from HCT was 9.8 years (range, 3 to 20). No adverse events were observed during CPET procedures, and 95% of studies were considered to be at "peak" effort (respiratory exchange ratio ≥ 1.10). VO2peak was on average 22% less than predicted, and allogeneic HCT survivors had markedly lower VO2peak when compared with autologous HCT survivors (18.2 mL/kg/min versus 22.2 mL/kg/min; P = .05). Six participants (30%) had VO2peak ≤ 16 mL/kg/min, a threshold associated with a 9-foldrisk of death in patients undergoing HCT. Despite the presence of normal (>50%) resting left ventricular ejection fraction in all participants, 25% had markedly abnormal left ventricular longitudinal strain, an advanced echocardiographic measure of myocardial dysfunction. These findings highlight the role of stress-based measures and advanced myocardial imaging to characterize CVD risk in HCT survivors, setting the stage for tailored interventions to prevent CVD with its attendant morbidity and mortality.

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Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

April 2017

Volume

23

Issue

4

Start / End Page

700 / 705

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survivors
  • Stroke Volume
  • Respiratory Function Tests
  • Oxygen Consumption
  • Middle Aged
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Exercise Test
 

Citation

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Armenian, S. H., Horak, D., Scott, J. M., Mills, G., Siyahian, A., Berano Teh, J., … Jones, L. W. (2017). Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant, 23(4), 700–705. https://doi.org/10.1016/j.bbmt.2017.01.006
Armenian, Saro H., David Horak, Jessica M. Scott, George Mills, Aida Siyahian, Jennifer Berano Teh, Pamela S. Douglas, Stephen J. Forman, Smita Bhatia, and Lee W. Jones. “Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors.Biol Blood Marrow Transplant 23, no. 4 (April 2017): 700–705. https://doi.org/10.1016/j.bbmt.2017.01.006.
Armenian SH, Horak D, Scott JM, Mills G, Siyahian A, Berano Teh J, et al. Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant. 2017 Apr;23(4):700–5.
Armenian, Saro H., et al. “Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors.Biol Blood Marrow Transplant, vol. 23, no. 4, Apr. 2017, pp. 700–05. Pubmed, doi:10.1016/j.bbmt.2017.01.006.
Armenian SH, Horak D, Scott JM, Mills G, Siyahian A, Berano Teh J, Douglas PS, Forman SJ, Bhatia S, Jones LW. Cardiovascular Function in Long-Term Hematopoietic Cell Transplantation Survivors. Biol Blood Marrow Transplant. 2017 Apr;23(4):700–705.
Journal cover image

Published In

Biol Blood Marrow Transplant

DOI

EISSN

1523-6536

Publication Date

April 2017

Volume

23

Issue

4

Start / End Page

700 / 705

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survivors
  • Stroke Volume
  • Respiratory Function Tests
  • Oxygen Consumption
  • Middle Aged
  • Immunology
  • Humans
  • Hematopoietic Stem Cell Transplantation
  • Exercise Test